165 - Balancing Efficiency and Safety: Perceptions of Clinicians on Secure Messaging within a Children’s Hospital

Publication Number: 3159.165

Preston Simmons, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Casey Pitts, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Brooke Luo, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Alexis Z. Tomlinson, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kimberly Albanowski, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Eric Shelov, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Melissa McLoone, Children's Hospital of Philadelphia, Merchantville, NJ, United States; Meghan Mcnamara, Children's hospital of philadelphia, Newtown Square, PA, United States; Halley Ruppel, University of Pennsylvania School of Nusing, Philadelphia, PA, United States

Background: Our quaternary care pediatric hospital introduced EHR-based secure messaging (SM) in June 2022 to meet the growing demand for in-the-moment inpatient communication. The introduction of this new technology has the potential to affect safety culture, particularly amongst different clinical groups across the hospital.

Objective: To evaluate the new SM communication system in terms of perceptions of workload burden and patient safety across clinician groups at a quaternary care children's hospital to inform future quality improvement efforts.

Design/Methods: Quality and safety experts developed a cross-sectional survey with demographic and likert scale questions based on prior safety literature to explore clinicians' perceptions of new SM platform. The survey was distributed via email to clinicians (e.g. nurses, physicians, advanced practice providers (APPs)) from March 1, 2024, to June 2, 2024 at a single children's hospital. Descriptive statistics were used to summarize participant demographics. Chi square analysis with Bonferroni correction was used to analyze differences in the distributions between clinician groups. Data was considered statistically significant at p < 0.05.

Results: A total of 440 clinicians completed the survey with nurses being the most common respondents (N = 165, 37.5%). When comparing Physicians/APPs (providers) and nurses, there was agreement that SM streamlined communication to the appropriate clinical team member (p = 0.096). Providers reported feeling more overwhelmed by the number of messages received (p < 0.001), being unable to review urgent messages in a timely manner (p < 0.001), and receiving a secure message that should have been a phone call or in-person communication (p < 0.001). Nurses were more likely to agree that SM helps to keep patients safe (p = 0.021). When physician groups were further stratified and compared to APPs and nurses, there were significant differences across all groups with resident physicians being the most likely to report increased workload from secure messaging (N = 35, 100.0%), being unable to review secure messages in a timely manner (N = 28, 80.0%), and feeling overwhelmed by the number of secure messages received (N= 33, 94.3%).

Conclusion(s): While there was a consensus about ease of communication with SM in reaching the appropriate clinical team member, discrepancies remain when looking at provider-specific workload and safety perceptions. These findings highlight the need for implementing strategies with diverse input from different clinical roles in the inpatient setting to mitigate the effects of high message volume and task switching.

Table 1: Primary Analysis of Differences in Physician/APP and Nursing Perceptions of Secure Messaging


Table 2: Sub-analysis of Perceptions of Secure Messaging Stratified by Physician Clinical Role